MRI-Guided Biopsy detects locally recurrent prostate cancer

Prostate cancer is the most common cancer in men. So far, the only tools available to detect and diagnose prostate cancer include: the PSA test and the transrectal ultrasound guided biopsy. Every year, about 20 million PSA tests are performed and about 1.2 million men undergo a biopsy. Traditional techniques such as the TRUS biopsy only sample the lower portion of the prostate – yet almost 30% of cancers are found outside this area. For this reason, only 30-40% of the 1.2 million biopsies performed on men each year are positive for prostate cancer.

The MRI fusion guided prostate biopsy plays a valuable role in evaluating low risk patients with active surveillance, as a way to follow up or monitor any change in their clinical status. The MRI fusion guided biopsy can also identify more aggressive cancers which need to be removed quickly in order to spare a patient’s quality of life and prevent metastasis.

A new study suggests that using MRI fusion-guided transrectal ultrasound biopsy can detect local recurrence of prostate cancer after radical prostatectomy, even in men with low PSA levels. The study was conducted at the National Cancer Institute in Baltimore, Maryland and was led by Baris Turkbey, MD.

The researchers identified ten men with rising PSA levels and no metastases after having had a radical prostatectomy. All of the men had suspicious lesions on initial imaging with MRI. The average diameter of the lesions was 1.12 cm. Using MRI fusion-guided transrectal ultrasound biopsy allowed the researchers to identify 62.5 percent of the target lesions as prostate cancer in 80 percent of patients, or eight patients. Among the patients with PSA levels less than 2 ng/mL, the MRI fusion-guided transrectal ultrasound biopsy technique found recurrent disease in 75 percent of the patients. Two cores per lesion were taken.

According to the researchers, “The prostatic fossa is notoriously difficult to biopsy, and these early results suggest that MRI-TRUS fusion guidance may aid in the localization of targets when compared with TRUS guidance alone.”

The researchers concluded that with early detection and diagnosis of recurrent local lesions using MRI-TRUS fusion biopsy, patient outcomes may be improved, especially when followed by early salvage treatment. However, more research is needed to confirm their findings. The study was recently published online in the journal Urologic Oncology.